Nurse in Kenya: August 2014

"...that one most perilous and long voyage ended, only begins a second; and a second ended, only begins a third, and so on, for ever and aye. Such is the endlessness, yea, the intolerableness of all earthly effort.”

- Herman Melville, Moby-Dick

"Thousands have lived without love, but not a one without water."

- W.H. Auden

It was nighttime. After a long day of med passes, an appointment into town, dealing with a few acutely ill kids, the regular chores, and forcing myself to slog through the fatigue of my sixteenth round of malaria, I had had enough of the day. My favorite way to end a long day here has often been to take a nice hot shower, have a cup of tea, and curl up in bed with a book. I wanted to be done with that day and I was more than ready for my shower. Not mentally present in the moment, I turned the cold metal knob. Nothing came out. “Ughhhhhh,” I sighed. I had forgotten. I tightened the knob and felt for a moment like I must be the most spoiled woman on Earth to be so frustrated by not having running water for a night. I went out to the kitchen, got a cup of drinking water from the designated container. I brushed my teeth and went to bed.

One day, back in the beginning of May, our borehole pump failed. I was in the main house when Terry Kiser, one of the “part-time missionaries” (who, with his wife Sandy, joins the team for a couple of months each year) popped into the kitchen, apparently having been working outside.

“Hey kid, how’s your prayer life lately?” He asked me.

That’s not a question I want to be asked. I thought, “Oh great, this one is a real holy roller. How long are these folks staying?” (That’s a joke, Ter.)

“Pretty good, I guess,” I hesitated. “Why, what’s up?”

He explained that he had been working at the borehole pump controls and that he thought we might have a problem on our hands. All I had heard up until that point was that there was an electrical problem – the pump motor kept shutting itself off. I didn’t give it much thought. Mechanical problems with the electricity, or with vehicles, or even sometimes with the water, are practically a daily occurrence. Not my department, you know. I suppose I’m kind of a technical ostrich: let me just close my eyes and turn my head the other way while you fix this or that problem since I know little about those things. I turned my head toward Terry and dusted the metaphorical sand out of my eyes and walked out with him to the box and then to the borehole. We put our hands on the box, and on the outside of the pump area, and prayed that God would guide him and Adam as they tried to repair it, that they could get the parts they needed, and that this would be resolved quickly.

That day our kind and diligent missionaries realized that we were, in fact, in trouble. The pump had failed and we weren’t getting any water out of the ground. They had to manually shut off all of the taps except for the one in the kitchen that let out water from one of the five thousand liter tanks that held what had been last pumped from the borehole. That kitchen water was used for drinking, food preparation, and the washing of plates and utensils. Adam and Terry took water that wasn’t being used from the clinic tank, at the other end of the compound, and trucked it up to the main house area for washing, bathing, and for the animals. Some of us took bucket baths, some of us didn’t. It was inconvenient but not unbearable. It did make me miss the water.

The guys worked really hard for those two days with the borehole pump technicians to figure out the problem – apparently the pump motor itself had burned out. It hadn’t been replaced in some time, maybe a year or a year and a half, so they figured it was time to replace it. They got it done. We had water back in two days.

I turned the knob and a crystal clear fluid poured out of the spoud and started covering my hands and slipping down the drain. I heard it trickling turbulently and examined it coming of the faucet. I keenly gazed at the stuff – I started to respect it more – it took the dirt off of my palms and out from under my fingernails and then it just disappeared down the pipes. Later, after the day was really done, I did get to take a shower. I thought, “Thank God that’s over. It was annoying not to have water for a couple of days and I missed this,” and then right away my thoughts were carried away to the relatively unimportant luxurious problems of my day. “We should load more WiFi credit,” and “Did my favorite jeans come back from the laundry,” and “my nail polish is chipping, I should really take it off.”

The next morning I got up, brushed my teeth, washed my face, refilled the water pitcher from sickbay, made coffee, and washed dishes, among other activities not immediately involving fresh water. The two-day water shortage was, as the kids are saying these days, “not a thing” in my mind. The moment I am about to describe was, however, “a thing” that I clearly remember. On my way to bring laundry out to the yard I ran into Adam in the doorway. He seemed uneasy.

“What’s the matter?” I asked.

“The pump isn’t working again,” he exhaled apprehensively, moving quickly past me. I felt my stomach twitch insecurely. I told myself, “they fixed it once, I’m sure it’s nothing.” I was wrong.

It would be two weeks before we would again pump water from the ground.

Here’s a little backstory. The borehole is eighty meters deep, accessing a pure underground river. It is the home’s only source of water of any kind. We use thousands of liters of water a day, all pumped from this borehole, to keep the house clean, to keep more than one-hundred-and-fifty children clean, to prepare food, to sustain twelve acres of farmland, to meet the needs of every person living on this compound, and of course, for drinking. We drink straight from the tap without chlorination and without filtering. We allow the community to draw from a tap at the edge of the compound every day so they can obtain free, clean water – and they take thousands of liters every day. The borehole pump makes it all possible: it brings what’s down there up to us, and then gets it into two five-thousand-liter tanks that we fill and empty more than once a day. This borehole system is the only water system available here on our compound today. The water company is Mother Earth, made possible to us by Father God, so to speak.

So, back to May – the pump failed a second time that morning – that’s why Adam looked so unsettled. Apparently we burned through a new pump motor in twelve hours: a major cause for alarm. Adam and Terry were all over it with phone calls and technician visits; they spent hours out there trying to figure out what had happened. They eventually realized, with the help of a Kenyan technician from Eldoret (80km away) who serendipitously was in the area on the day we called for help, that a high sediment concentration in the borehole itself caused the pump motor to seize and fail. While we were pleased to have a diagnosis, it was bittersweet: it was realized that the problem wasn’t with the borehole pump, but with the borehole itself. It needed to be flushed – a technically strenuous process that’s very expensive and which requires specialized equipment.

The taps went off again, and we were rationing drinking water that was left from the tanks. In the twelve hours that we did have water we were able to fill the tanks again, so we filled what we had lost in that time. Everyone in the home was charged with the responsibility of the judicious use of that clean water we had last pumped up. It was exclusively “for things that go in our mouths, or for things we need to put other things in our mouths.” Drinking, food prep, and meal service: that’s it.

Within a day or so Terry, Adam, and Carla arranged for water to be trucked in for washing, laundry, bathing, and farm use. A truck came with a large water tank on the back that displayed the words “CLEAN WATER” suspiciously painted across it. We explained to the children and staff that this water was not clean enough to drink, and that it was in fact from the mtoni (river) nearby. We did the best we could. The place was kept clean, if it was maybe even a bit more off-white than normal.

Back in April I had noted a mysterious and uncharacteristic increase in the number of cases of gastrointestinal illness not otherwise attributable to typhoid fever or to malaria. Throughout April I had heard the words “Julia, tumbo ni kali,” (Julia, belly hurts) form, in all likelihood, the most commonly uttered phrase encountering my ears during that period. I poured out quite a bit of metronidazole (Flagyl) and a fancy little cocktail called Entamaxin, containing metronidazole and a chemical known as diloxanide furoate, which targets amoebic disease. I followed orders dictated by the local physician – we tested for what was most likely, treated what was next most likely, and then did more tests if the kids were still sick. Most of them became well before the water crisis even happened. When I heard that we had high sediment levels in what was being pumped, however, I was almost pleased to have an answer to the tummy-bug question that was the month of April.

And so, the tankers of water came and we emptied them and they drove away. We took barely translucent, actually light brown water and put it in pots on the sink and warmed it so we could bathe in buckets. Sometimes when I didn’t have the time or energy to boil the water I used a few new cloth diapers (we use them as dishtowels as we could never use them on the babies) to sieve some of the brown out and then just bathed cold. Our bodies were itchy and we smelled a bit off, but it was better than nothing. The kitchen was dirty – without water coming out of the tap on demand, and having to haul whatever we needed for cleaning, many nights it was just easier to leave the floor dirty and the dishes undone. Whenever it rained we put collection tanks, basins, and buckets outside to collect runoff from the roofs. It got old really fast and I was forced to confront an unseemly and embarrassing truth about how spoiled I really have been all my life.

This spoiled half-grown-up lady from Nassau County, Long Island, walked her rear-end out into the Kenyan nights with a flash light and un-stuck the corn cob that was shoved into the end of the PVC pipe out of which our “clean water” would come so she could bathe and flush the toilet and wash her underwear, just like everyone else had to do. I walked out there with my blood pressure a little higher than normal, with a healthy disapproval of my own reticence, and walked back with a bucket or two. I learned to carry water on my head just like a Kenyan woman. I walked back and forth with buckets and sometimes it would spill down the back of me and I’d shriek a little. In those walks I was confronted by a quietly resigned awareness of blessed I really am, that I take so much for granted, and that I will probably always “have it better” than so many people who walk this Earth on no lowlier or no higher a path than I do. Even in that irritating chore of having to haul water around, I was still more fortunate than a significant portion of the world’s population.

According to water.org[1], 773,000,000 people do not have access to clean water in Africa, South and Central America, and Asia, compared to only 10 million who lack access in developed countries. Three-quarters of a billion people on this planet would have loved to trudge even ten times further than I did for just two weeks to get water that wasn’t even half as clean as ours was, likely to drink it. It’s estimated that women alone spend two-hundred-million hours per day collecting water in our world, and they do it with babies on their backs, and firewood under their other arms.

When I examine my life squarely, I have come to realize that I have never gone without anything. Ever. There has never been a single instance in my life when I really needed something that I was not able to obtain. I have never been hungry, I have never been thirsty, I have never been cold or without medicine. Not only have I received everything I have ever needed, but I have also been able to get my hands on almost everything I have ever wanted. As grateful as I am for this, even alongside the fact that I don’t feel guilty about this, somehow I feel that this is a frankly vulgar and nauseating realization.

Let’s get real here: I grew up in Old Westbury, New York, which was implicated in 2007 by businessweek.com[2] as the most expensive suburb of New York City. I grew up complaining to my parents about the brands of clothing I wasn’t wearing, or the model of car they weren’t driving, or what new frivolous trend I believed I would die without. I’ve asked my parents about this and they do say that I wasn’t a completely spoiled brat, but I think they’re biased. No, we didn’t live the typical Old Westbury lifestyle (and we are all more than okay with that today, no offense to anyone who is fortunate enough to live there) but I never went without. I was devastatingly preoccupied with what I believed I desperately needed from the Roosevelt Field Mall, meanwhile my father and mother worked very, very hard to keep my brother and me in private schools, clean clothes, and good health. I had food on my dinner plate, hot running water always coming out of the faucet, electricity and Internet access literally constantly, and two skilled medical professionals in the house to flinch every time I coughed. I had everything and I wasn’t grateful. Now I’m twenty-six, am supported by donor income since quitting my “real job” a year ago, living at an orphanage in rural Africa, realizing that it’s only when I started to “lack” the essentials did I really discover them.

Rereading my own blogs, it seems like I write to you primarily to share with you the epiphanies I experience out here in the bush. Sometimes they come softly and subtly over time, with a mild approach and a gentle arrival. Other times these epiphanies feel like they have been violently grilled onto the grey matter of my cerebral cortex: unsettling advents of viscerally stirring realizations. I’m frankly not sure where on the spectrum of revelatory severity this particular issue lies, but it doesn’t feel as benign as my axiomatic “comfort zone” would prefer.

A man who once worked hard to help me realize some critically important facets of my life, Gerry Johansen, advised me to read a book titled Chop Wood, Carry Water by Rich Fields; Gerry wanted me to embrace the spirituality of everyday living even in seemingly insignificant tasks. My dad and stepmom bought me the book six years ago and I opened it but can’t tell you a single word of it. Maybe I wasn’t ready for the lesson yet, and had to learn it with a pail of water in each hand.

Somewhere in the steps between the “CLEAN WATER” truck and my bathroom (yeah, the one only I use; really roughing it out here) I realized that I felt some kind of strange privilege to be forced to carry that water. It was dirty, it smelled, and I would be surprised if it wasn’t teeming with Giardia, Entamoeba, and other protozoa, at least. Carrying more than I knew I could, my arms burning, somehow I felt like I finally arrived as a human being. I had to work for something on a very basic human level. I was going to be able to flush my toilet and wash my hair because I actually exerted effort to obtain something fundamentally required for human life in order to do things that really weren’t integral to my survival. I wasn’t even drinking this water. I suppose I tasted, just for a minute, the most infinitesimal morsel of what it must be like to live in most of the developing world.

I stood there staring at the toilet, and the sink, and the showerhead, and the spigot coming out of the wall near the floor of the shower. I turned the tarnished knob attached to the stained porcelain sink and heard the pipes belching and spitting out meters of air. Water started sneezing out of it in an erratic stream and I waited. Within just a few seconds the flow was steady, clear, and silent. I closed the valve. There was a diamond-shimmer on the sink, the wet reflection of the fluorescent ceiling against the chilled surface. I wanted to remember what it felt like to know the power and the privilege of having this mysterious liquid, upon which my life and all the lives of these children depend, on demand. In that moment I remembered once standing over a young woman who was in full cardiac arrest in the ICU after attempts to control her traumatic internal hemorrhaging in the OR had obviously failed. To some people in this world, what I had just let spit out of the faucet and fall down the drain had been as precious as the blood spilling out into that woman’s peritoneum. Some people in this world, obviously with clinical ignorance and dying of thirst, would probably give up a pint of their own blood for a pint of water. I picked up my toothbrush, wiped a bead of toothpaste on it, opened the valve, wet the brush, and closed it again. How I respected the water that day.

Two weeks after the second pump failure a rig came and did flush the borehole. The pump was repaired, and after some electrical issues were resolved with the system, we had water again. It flowed out of the tap and the showerhead and it was clear and beautiful and perfect. I could see through it and watch the light dance around in it. I watched as it carried away every speck of brown clay, every crystallized smear of the dried drool and tears of babies, every blood-red stain of rifampin, and every worry I had wrapped myself in that day. This was powerful stuff – it was more of me than I was ever of it. We had our water back and we used it. I’d like to think I learned how to get by with less water and more gratitude. We are thanking and praising this Awesome God of the Universe for His help with this.

I’d really like to tell you that this is the end of the entry and to please enjoy the lovely photos now – especially because at this minute I have to pause to pour medicine cups and give injections – but the story isn’t over. No, the pump didn’t fail again, but we’re still hauling water… kind of. Today our problem isn’t so much in getting the water as it is in getting rid of the water. This time, the tap is flowing and the drain is full.

For as long as the children’s home has had plumbing, it has “gotten by” with one main septic system – a traditional septic tank that leaches into the ground. (I know that might be alarming to hear, given my recent explanation of how we get our water from that very same ground, but its thought that eighty meters down there is enough natural filtration to allow the water to maintain its purity. We also recently tested the water just after the pump was replaced and it was found acceptable for human consumption by a professional analysis.) To make a very long story short: the septic tank is full. The equipment required to drain these tank is simply not available and the only drainage of them is by natural means through leaching (which isn’t going very well) and by pumping some of the waste out of the tank and down into a choo (latrine).

As we anticipated the inability for our septic tanks to accommodate the large amounts of solid waste produced by the more than two-hundred people on the compound daily, many of whom still exclusively use latrines, we realized the need for a comprehensive and fully-integrated wastewater treatment system to serve the entire compound. Our hope for wastewater management was to find a system that could intake waste and, after treatment, release recycled, nitrogen-rich effluent for purposes other than drinking. The appropriate wastewater treatment system, and its developer, has now been identified. This project is a tremendous undertaking and right now we simply don’t have the money for it.

We’re not getting a new septic tank, we’re not building the wastewater treatment system yet, and we’re not really finding another quick solution. We’re not able to move in the older girls into the upper level of Dorm One because we don’t have plumbing hooked up to that dorm at all, and we don’t want the girls to have to use the same latrines as the boys, or bathe in the same area. Even when we build Dorm Two, as teams from New York have been working on this summer, we won’t be able to really use it fully until we have a wastewater system that can be integrated into it; more septic tanks are simply not an option. In some ways, we’re not moving forward as much as we could because we are limited by the wastewater management factor.

I can tell you, however, what we are doing. We are hauling out wastewater from sinks and showers and pouring it on the flowers. We are waiting to flush the toilet until it’s absolutely necessary. We’re taking the shortest showers possible, water-on/water-off/water-on/water-off style. Today this problem doesn’t seem much like anything compared to not having water coming out of the tap, but I’ll say that not being able to put much down the drain is at least a minor inconvenience for us. On the other hand, it’s a major inconvenience for the guys (now Jeff and Adam, as Terry is back in the States and Jeff returned from his leave in June) to have to manually manage the raw sewage output from an entire orphanage.

There’s something else we’re doing: we’re raising money. We’re looking into grants, we’ve talked to the Gates Foundation, and we’re explaining the situation to anyone who will listen. At this moment, if you are reading this, that means you. We need to raise at least $150,000USD for this project. The last time I checked, we were less than ten percent of the way there so far. If you, or someone you know, is involved with wastewater projects and would be willing to get involved, please email me at jfracassa@gmail.com. If you are willing to contribute toward this wastewater campaign, please visit https://connect.egiving.com/where-most-needed120/rehema-ministries and in the “Note” and “Comment” box type “Wastewater” to designate your donation, and select “building projects” from the drop-down menu marked “Purpose”.

I know, the missionary is asking for money again, but this time it isn’t for me or even for my work. Being able to manage our human waste in a sanitary and sustainable manner is critical to the health of every person on this compound and as the nurse it’s my job to advocate for my patients. In this case, prevention is key, and we need to be able to properly manage waste in order to prevent illness.

That’s really it, that’s all I can tell you about the wastewater right now – there’s a problem, and we’re working in the gray area (er, brown area) in between manageability and crisis to get by day to day. Instead of hauling buckets of half-clean water inside from outside, now we carry basins of half-clean water outside from inside. Again, it’s nothing like it was before, but is characteristic of what seems to be the tradition of living in the developing world: there are challenges upon challenges. New solutions bring new challenges, the overcoming of which requires nothing less than the interminable endurance of the minds of our missionary men here, and the substantively realized Grace of God.

As inconvenient as it may sound, or as frustrated as I might seem, know that on a daily basis our team simply puts one foot in front of the other, “in step” with the requirements and luxuries of the day. There’s a provision that has been made for us here on this compound fundamentally: in the ability to have the land, the water, the electricity, the food, and most importantly, the children. To quote one of my teammates, “I don’t know what we’re worried about or complaining about with the water. There are one-hundred-and-fifty-three little miracles running all around us and we think we’ve got problems?” I suppose it’s a matter of perspective.

I frequently find myself falling into a negative way of thinking about life – that I’ll be happier when. The proverbial when follows me like a shadow: my own mind creates an atmosphere of conditionality that stifles the ability for joy to really grow. This experience has reminded me that, in any circumstance of water or no water, drainage or no drainage, struggles or no struggles, pain or no pain, gratitude for what I have right now will create the joy that negativity lies about. Waiting for joyfulness to precede gratitude has left me realizing I’ve missed the train, standing alone at an empty station. Allowing gratitude to precede joy has, in fact, created the trains themselves, and all of their journeys, and all of their destinations.

Yesterday I went out to the babies to just check them out and make sure nobody was sick. These brown little angels ambled over to me and showed me their tiny teeth as they smiled and giggled. I blew raspberries on their tummies and tickled them all in a row, back and forth, until I was dizzy. Remember when you were a kid in the toy store and a line of noisemaking dolls were lined up, and you’d push buttons on all of them as fast as you could to get them all chiming away at once? That’s what I did yesterday, for like fifteen solid minutes. I had six or seven babies, some lying down in front of me, and some climbing all over me, giggling and cooing and snorting out fits of the sweetest laughter I can ever imagine hearing. I wasn’t here in that moment – I was in some higher or deeper place, free of wastewater problems and borehole pumps, free of the materialism of my youth and of the imagined scarcity of recent days. The harmony of a handful of the most beautiful babies I’ve ever known, those who, in great irony, had been previously discarded and disregarded, is to me the most perfect sound, undoing the frustration of any inconvenience. The laughter of these wee ones reminds me that the only way to really live is to show up to the moment: to pour myself into it, and to receive the abundant outpouring of refreshment from the endless spring of reality.

And now, do enjoy the photos.